Long-Term Residential Care and Mutual Help Societies

Some people with alcohol dependence relapse repeat­edly in spite of multiple treatment episodes. Long-term residential treatment is used in some countries for alco­holics who do not respond to more limited efforts at rehabilitation. Unfortunately, the effectiveness of these programs has not been evaluated systematically.

In con­trast, continuing care by means of aftercare groups and other mutual help organizations has received increased research attention. For example, a study of the long-term outcomes of treated and untreated alcoholics (Timko et al, 2000) found that individuals who obtained help for a drinking problem, especially in a timely manner, had better outcomes over 8 years than those who did not receive help. The type of help they received (e.g., mutual help societies or specialized treatment) made little difference in long-term outcomes.

Although mutual help societies composed of recover­ing alcoholics are not considered a formal treatment, they are often used as a substitute, an alternative, and an adjunct to treatment. With an estimated 2.2 million members affiliated with more than 100 000 groups in 150 countries, Alcoholics Anonymous (AA) is by far the most widely utilized source of help for drinking problems in the world. Related organizations have been developed in a number of other countries, such as Danshukai in Japan, Krcuzbund in Germany, Croix d’Or and Vie Libre in France, Abstainers Clubs in Poland, Family Clubs in Italy, and Links in the Scandinavian countries.

Although it is regarded as one of the most useful resources for recovering alcoholics, the research literature supporting the efficacy of AA is limited. Attendance at AA tends to be correlated with long-term abstinence, but this may reflect motivation for recovery. Several large-scale, well-designed studies (Walsh et al, 1991; Ouimette et al., 1999) suggest that AA can have an incremental effect when combined with formal treatment, and AA atten­dance alone may be better than no intervention.

When AA is combined with a 12-week individual therapy called Twelve Step Facilitation (TSF), one study (Babor and Del Boca, 2003) found that TSF not only increased affiliation with AA, it also had a demonstrable effect on clients whose social networks contained many drinking compa­nions. This study suggested that AA is effective because it helps to change the drinker’s social environment, rather than through some form of spiritual conversion.

Special Features Influencing Treatment. There is considerable evidence that links the outcome of alcohol dependence treatment to comorbid psycho­pathology. General measures of psychopathology, as well as the specific diagnoses of drug abuse, drug dependence, antisocial personality disorder, and major depressive dis­order predict poorer outcomes in alcoholics (Edwards et al., 2003). Demographic characteristics such as age, gender, and socioeconomic level also influence treatment outcomes.

A wide variety of treatment approaches have been adapted to suit the needs of women, adolescents, and the elderly, including multidisciplinary inpatient treatment programs, outpatient individual therapy, group therapy or day treatment, and outpatient recovery support groups. Although treatment programs with experience in treating these groups are better able to coordinate rehabilitation with medical and social services, there is little evidence that tailored treatment settings produce better outcomes than more generic programs.